Med Surge Endocrine 2 from Mom
B. calcium gluconate.
he first priority for treating hypoparathyroidism is to administer: A. 500 mL of normal saline. B. calcium gluconate. C. vitamin D. D. calciferol.
B. Ventricular tachycardia Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular. Ventricular tachycardia is characterized as a wide complex (QRS duration greater than 120 milliseconds) tachyarrhythmia at a heart rate greater than 100 beats per minute. It is classified by duration as non-sustained or sustained. Non-sustained ventricular tachycardia is defined as more than 3 beats of ventricular origin at a rate greater than 100 beats per minute that lasts less than 30 seconds in duration.
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: A. Premature ventricular contractions B. Ventricular tachycardia C. Ventricular fibrillation D. Sinus tachycardia
B. Atrial fibrillation Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled). Atrial fibrillation is the most common type of cardiac arrhythmia. It is the leading cardiac cause of stroke. Risk factors for atrial fibrillation include advanced age, high blood pressure, underlying heart and lung disease, congenital heart disease, and increased alcohol consumption.
A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: A. Sinus tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Ventricular fibrillation
D: "I will be sure to eat lots of cheese, tofu and spinach."
A patient is being discharged home after hospitalization with hypocalcemia. Which statement by the patient indicates she understood the dietary instructions?* A. "I will avoid sardines. B. "I'll avoid salt and Vitamin-D supplements." C. "I will tell my husband to only purchase skim milk." D. "I will be sure to eat lots of cheese, tofu and spinach."
C. The other options are normal readings...however, patients with myxedema coma should not receive sedatives or narcotics (Fentanyl is a narcotic) because these patients are very sensitive to them. Therefore, the nurse should intervene and question the doctor's order.
A patient is receiving treatment for myxedema coma with IV Synthroid. Which of the following findings would require nursing intervention for this patient?* A. Blood glucose 75 B. Sodium level of 138 C. A physician's order for Fentanyl 0.25 mcg every 2 hours for pain D. Temperature 98.9 'F
D. Synthroid should be taken in the morning without food so absorption is not affected. All the other options are incorrect discharge education for patients suffering from myxedema coma.
A patient is recovering from myxedema coma and will be discharged tomorrow. What will you include in their discharge teaching?* A. Avoiding green leafy vegetables. B. Importance of taking Tapazole exactly as prescribed at the same time every day. C. Limiting foods with Iodine such as kelp, dairy, and eggs. D. Importance of taking Synthroid in the morning without any food.
C: Calcium 6.9 Patients who have had any type of neck surgery, especially parathyroid or thyroidectomy is risk for hypocalcemia.
A patient is recovering from parathyroid surgery. Morning labs values are back. Which of the following lab values would correlate as a complication from this type of surgery?* A. Calcium 8.7 B. Calcium 12.5 C. Calcium 6.9 D. Calcium 9.2
C. The patient is receiving IV Synthroid. Therefore, the nurse must monitor for toxicity which would present with elevated THYROID levels. Remember Synthroid is a thyroid replacement medication. This would present with the patient complaining of feeling hot, chest pain, tachycardia, and hypertension (similar signs and symptoms of HYPERthyroidism).
A patient taking IV Synthroid starts to complain of feeling hot and chest pain. On assessment, you find that the heart rate is 125 bpm and blood pressure is 200/103. You immediately notify the physician of the patient's condition and receive orders for lab work. Based on the patient's signs and symptoms, what is the MOST important lab result at this time to determine the cause of the patient's symptoms?* A. Potassium level B. Thyroid levels C. Calcium level D. Sodium level
A: Initiating seizure precautions are priority because this is a critically low calcium level and the patient is at risk for seizures. Next, you would educate the patient about calcium rich foods and administer vitamin D supplements as ordered. Calcitonin is for HYPERcalcemia.
A patient's calcium level is 6.9. Which of the following is a nursing priority?* A. Initiate seizure precautions B. Educate patient about foods rich in calcium C. Administer Calcitonin D. Administer Vitamin D supplements as ordered
D: Hypercalcemia
A patient's lab work shows that they have a high parathyroid hormone level. Which condition is the patient at risk for?* A. Hyperkalemia B. Hypocalcemia C. Hypokalemia D. Hypercalcemia
A in the morning to prevent insomnia
A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: A in the morning to prevent insomnia B only when the client complains of fatigue and cold intolerance C at various times during the day to prevent tolerance from occurring D three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels
A. hoarseness of voice
After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? A hoarseness of voice B difficulty in swallowing C tetany D fever
C HYPERtonic or normal saline solutions are used to treat myxedema coma due to the present of hyponatremia....not HYPOtonic solutions.
All of the following are treatments for myxedema coma EXCEPT?* A. Corticosteroids B. IV glucose C. Hypotonic IV solutions D. IV Synthroid
C. hypercalcemia.
An elderly woman with hyperparathyroidism is also likely to have: A. hypophosphatemia. B. hyponatremia. C. hypercalcemia. D. osteomyelitis.
C Treat hypotension - As part of the stabilization of the patient, the nurse should maintain RESPIRATORY status, treat HYPOtension, and treat hypothermia
As part of treatment for myxedema Coma, the nurse should A Maintain cardiac status B Treat hypertension C Treat hypotension D All of the above
D. autoimmune-induced atrophy of the gland
Causes of primary hypothyroidism in adults include A malignant or benign thyroid nodules B surgical removal or failure of the pituitary gland C surgical removal or radiation of thyroid gland D autoimmune-induced atrophy of the gland
D & E Studies would show elevated PTH levels, ELEVATED serum calcium, DECREASED serum phosphate
Diagnostic studies for hyperparathyroidism may include - select all that apply A Elevated THC levels B Decreased serum calcium levels C Increased serum phosphate levels D Elevated urine calcium, uric acid and creatinine E Bone density measurement
B. Thyroid crisis
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A Diabetic ketoacidosis B Thyroid crisis C Hypoglycemia D Tetany
A. Hypocalcemia
For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? A Hypocalcemia B Hypercalcemia C Hypokalemia D Hyperkalemia
B Loss of appetite C Muscle Weakness E Shortened attention span In addition, constipation, fatigue and emotional disorders are symptoms of hyperparthyroidism
Grandma Betty is admitted to the ER with the suspicion of hyperparathyroidism. Which of the following would confirm the diagnosis? Select all that apply A Agitation B Loss of appetite C Muscle Weakness D Visual abnormalities E Shortened attention span F Loss of memory
B. Assisting the patient to breathe and warming them to raise the body temperature to normal.
How is myxedema coma treated? A. Most commonly, the thyroid hormone is replaced in patients. B. Assisting the patient to breathe and warming them to raise the body temperature to normal. C. Nothing medical is done, besides bed rest and drinking a lot of water.
A: calcium, phosphate
Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels?* A. calcium, phosphate B. phosphate, calcium C. calcium, sodium D. sodium, calcium
A Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood.
Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood. A. True B. False
B. tetany
Nursing care of the client with hypoparathyroidism must consider the client's risk for injury due to: A. falls. B. tetany. C. altered thought processes. D. impaired memory.
D All of the above
Possible causes of an isoelectric ECG (Flat line) include: Question 4/10 A Loose leads or leads not connected to the patient or defibrillator/monitor B No power to the monitor C Gain or amplitude too low D All of the above
D Any organized rhythm without a pulse is defined as PEA. An organized rhythm consists of QRS complexes that are similar in appearance from beat to beat (ie, each has a uniform QRS configuration). Organized rhythms may have narrow or wide QRS complexes, they may occur at rapid or slow rates, they may be regular or irregular, and they may or may not produce a pulse.
Pulseless Electrical Activity is defined as: Question 3/10 A No electrical activity present on an ECG B A perfusing rhythm without spontaneous respirations C Ventricular Fibrillation D Any organized rhythm without a pulse
C If bag-mask ventilation is adequate providers may defer insertion of an advanced airway.
Routine insertion of an advanced airway in asystole: Question 6/10 A Is contraindicated in a patient in asystole B Should take priority over gaining IV/IO access C Should only be performed if ventilations with a BVM are ineffective D Is necessary so the epinephrine can be given
A Renal failure is by far the most common cause of secondary hyperparathyroidism. If kidneys are unable to convert vitamin D to its active form, serum vitamin D levels will drop. Lower vitamin D levels reduce the absorption of calcium in the intestines and reduce the kidneys' ability to resorb calcium from the urine. In addition, if the kidneys are unable to adequately excrete phosphate, calcium phosphate forms, which further lowers free calcium levels in the blood. Poor nutrition is not a common cause of secondary hyperparathyroidism, though low vitamin D levels due to malabsorption can be a contributing factor. Pituitary tumors can be seen with hyperparathyroidism when part of multiple endocrine neoplasia type I, but this is not as common as renal failure. Bone cancers are more often associated with elevated calcium levels, resulting in low or undetectable parathyroid hormone levels.
Secondary hyperparathyroidism is the result of chronically diminished levels of serum calcium. Depressed levels of serum calcium leads to a compensatory increase in the activity of the parathyroid glands. What is the most common cause of secondary hyperparathyroidism? A Renal failure B Pituitary tumor C Poor nutrition D Bone cancers
B Increased blood pressure E Altered bone density and formation In addition side effects include hypokalemia, HYPOcalcemia, delayed healing, elevated blood glucose, susceptibility to infection, mood behavior changes, fat distribution to face and trunk
Side effects of corticosteroid therapy include - select all that apply A Hypercalcemia B Increased blood pressure C Feeling of euphoria D Swelling of hands and feet E Altered bone density and formation
A. Fever D. Blood glucose level greater than 350
Signs and Symptoms of myxedema coma include all of the following EXCEPT? Select all that apply:* A. Fever B. Bradycardia C. Sodium level less than 135 D. Blood glucose level greater than 350 E. Hypothermia
B: Chvostek's Sign
Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as?* A. Trousseau's Sign B. Chvostek's Sign C. Homan's Sign D. Goodell's Sign
B A pulse oximeter reading of less than 93% is significant. A 90% pulse oximeter reading indicates a PaO2 of approximately 60 on an arterial blood gas test; this is severe hypoxemia and requires immediate intervention.
The client is admitted to the intensive care department diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? A Serum blood glucose level of 74 mg/dL. B Pulse oximeter reading of 90%. C The client is lethargic and sleeps all the time. D Telemetry reading showing sinus bradycardia.
D Chvostek's is correct. The test for Chvostek's sign is performed by tapping the facial nerve (C7) and the trigeminal nerve (C5) and observing for grimacing. Kernig's sign is nuchal (neck) rigidity associated with meningitis. Chadwick's sign is a bluish vagina associated with hormonal changes. McBurney's sign is rebound tenderness associated with appendicitis.
The nurse is checking for hypoparathyroidism. To check for hypoparathyroidism, the nurse can check for the positive presence of which of the following signs? A Chadwick B McBurney's C Kernig's D Chvostek's
D Glands which regulate the calcium in our bodies - Parathyroid regulates calcium and phosphorus, secretes PTH and will take calcium from the bones to the bloodstream when Ca is low
The parathyroid is A A butterfly-shaped gland that sits low on the front of the neck. B A small, bean-shaped gland situated at the base of your brain C Glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol D Glands which regulate the calcium in our bodies
A. balanced thyroid.
The term euthyroid is used to describe: A. balanced thyroid. B. hyperthyroidism. C. hypothyroidism. D. Graves' disease.
A. Infections D. Drugs E. Heart Attack F. Trauma
This/These can be certain sudden triggers of myxedema coma. A. Infections B. Excitement C. Broken Bone D. Drugs E. Heart Attack F. Trauma
C IV of sodium chloride and furosemide - this will increase urinary excretion of calcium
Treatment for severe hypercalcemia would include A IV of saline and antibiotics B Prescription of lasix C IV of sodium chloride and furosemide D IV of sodium bicarbonate and lasix
C. Fatigue
What is a symptom of hypothyroidism? A. Darker skin B. Lack of concentration C. Fatigue D. Weight loss
A Parathyroid adenoma Primary hyperparathyroidism is most commonly due to a parathyroid adenoma. 80-90% of cases of primary hyperparathyroidism are due to parathyroid adenoma. 10-15% cases are due to parathyroid hyperplasia, and parathyroid carcinoma accounts for 1-5% of all cases.
What is the most common cause of primary hyperparathyroidism? A Parathyroid adenoma B None of these C Parathyroid carcinoma C Parathyroid hyperplasia
C Simulate hormones - corticosteroid therapy simulates cortisol, an anti-inflammatory hormone secreted by the adrenal glands
What is the purpose of corticosteroid therapy? A Manage pain B Regulate hormones C Simulate hormones D Block hormones
D None of the above Instructions would include Take in the morning with food to decrease gastric irritation Do not stop abruptly! Withdrawal symptoms include weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain Consider osteoporosis with prolonged use (>3 months), encourage calcium supplements, exercise.
When educating a patient on the use of corticosteroids, nurse Heather would do which of the following? A Encourage the patient to take immediately before bed when there is no risk associated with operating heavy machinery B Stop the use of corticosteroids as soon as possible so your body does not build up a tolerance to the medication C Do not take with any other over the counter supplement D None of the above
C. Iodine toxicity can cause HYPERthyroidism issues not HYPOthyroidism issues.
Which of the following are NOT a cause of myxedema coma?* A. Illness B. Sedatives C. Iodine Toxicity D. Thyroidectomy
D: Thiazide Diuretics
Which of the following is not a cause of hypocalcemia?* A. Low parathyroid hormone B. Crohn's Disease C. Acute Pancreatitis D. Thiazide Diuretics
B. Elderly females are at most risk for myxedema coma. In addition, Lithium decreases thyroid hormone and if the patient has missed several doses of Synthroid (used to treat HYPOthyroidism) this puts them at the greatest risk of myxedema coma.
Which of the following patients are MOST at risk for developing myxedema coma?* A. A 28 year old female who is prescribed Methimazole. B. A 75 year old female who is taking Lithium and reports missing several doses of Synthroid. C. A 69 year old male experiencing nausea and vomiting for 4 days. D. A 55 year old male with a history of diabetes and is insulin dependent.
D None of the above - the nurse should begin IV thyroid replacement therapy and manage HYPOnatremia and HYPOglycemia
Which of the following should a nurse initiate to treat someone with myxedema coma? A Begin saline IV upon admission to the hospital B Manage hypernatremia and hyperglycemia C Obtain vital signs D None of the above
All of these are things you should monitor in a patient with hypothyroidism. In addition, H&P, thyroid tenderness, other vital signs, skin condition, speech, weight or appetite changes, constipation and the administration of medication are also things a nurse will do. Patient comfort, though not explicitly listed on your slides may indicate issues with medication, swelling (edema) or other things you should monitor for
Which of the following should you, as a nurse, assess in a patient with hypothyroidism? Select all that apply A Patient comfort B Mental status C Blood pressure D Presence of swelling E Cold intolerance F Patient knowledge
A There is no evidence that attempting to "defibrillate" asystole is beneficial. In one study, the group that received shocks had a trend toward worse outcomes. If it is unclear whether the rhythm is fine VF or asystole, an initial attempt at defibrillation may be warranted.
Which of the following statements is true? A There is no evidence that attempting to "defibrillate" asystole is beneficial B The AHA recommends the use of TCP for patients with asystolic cardiac arrest C CPR should be interrupted while establishing IV or IO access in asystole patients D Identifying the cause of asystole is not important
D. Assess for a patent airway. Rationale: Hypoparathyroidism is cause bronchospasm and laryngeal spasms leading to respiratory distress. It is most important to ensure a patent airway first. All other interventions are important, but not the highest priority for this client.
Which one of these nursing actions is the highest priority for a client admitted with acute hypoparathyroidism? A. Provide a quiet, dimly lighted room. B. Assess for abdominal cramps. C. Provide a diet high in calcium. D. Assess for a patent airway.
